Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
New Children's Hospital, Pediatric Research Center, Helsinki, Finland.
Am J Trop Med Hyg. 2023 Feb 27;108(4):851-856. doi: 10.4269/ajtmh.22-0650. Print 2023 Apr 5.
In areas with suboptimal resources, blood transfusion may not be feasible even when mandatory for severely anemic children with a life-threatening disease. We evaluated how much not having received a transfusion affected the survival in 171 children with an admission blood hemoglobin level of < 6 g/dL and bacterial meningitis in Luanda, Angola. Of these children, 75% (128 of 171) had received a blood transfusion during hospitalization, but 25% (43 of 171) had not. Within the first week, 33% of patients (40 of 121) with transfusion and 50% (25 of 50) without a transfusion died (P = 0.04). Early transfusion (days 1-2 of hospitalization) prolonged the time of survival from a median of 132 hours [interquartile range (IQR), 15-168] to 168 hours (IQR, 69-168; P = 0.004), and had odds of 0.49 (95% CI, 0.25-0.97; P = 0.040) for death compared with no transfusion. The effect of transfusion/no transfusion at any time during hospitalization on mortality within 30 days, and prolongation of the time of survival were similar to early transfusion but showed even clearer benefits. Our results emphasize the value of timely transfusion in facilities that care for severely anemic children with severe infections to maximize their chances of survival.
在资源不足的地区，即使对于患有危及生命疾病且严重贫血的儿童有强制性输血的要求，也可能无法进行输血。我们评估了在安哥拉罗安达入院时血血红蛋白水平<6g/dL 且患有细菌性脑膜炎的 171 名儿童中，未接受输血对生存的影响。在这些儿童中，75%（171 例中的 128 例）在住院期间接受了输血，但 25%（171 例中的 43 例）未输血。在第一周内，接受输血的患者中有 33%（121 例中的 40 例）和未输血的患者中有 50%（50 例中的 25 例）死亡（P=0.04）。早期输血（住院的第 1-2 天）将生存时间中位数从 132 小时（IQR，15-168）延长至 168 小时（IQR，69-168；P=0.004），与未输血相比，死亡的几率降低了 0.49（95%CI，0.25-0.97；P=0.040）。在住院期间任何时间输血/不输血对 30 天内死亡率的影响以及对生存时间的延长与早期输血相似，但显示出更明显的益处。我们的研究结果强调了在治疗严重感染导致严重贫血的儿童的医疗机构中及时输血的价值，以最大限度地提高其生存机会。
